When done well, multidisciplinary clinics are intellectually stimulating, provide cohesive patient care & create valuable relationships with our clinical partners.
Educational opportunities amplified: The concentration of interesting pathology and the ability to learn from outside specialists make multidisciplinary clinics favorites among fellows and residents. In addition to bedside learning, some of these clinics have formal conferences.
On the first Friday of every month, one hour of the Rheumatology–Dermatology Clinic is reserved for a rotating provider to present a complex patient. The provider and patient have the opportunity to ask opinions of numerous colleagues, and the whole group is able to learn from a complex case.
The OHSU Center for Interstitial Lung Disease has a monthly multidisciplinary conference in which chest radiology, pulmonary and rheumatology specialists discuss complex patients, share information and present pertinent journal articles.
Practical Challenges & Proposed Solutions
Time: Combined clinics naturally attract patients with multi-system disease, who require more time and care coordination. The other consideration, however, is that time is saved when coordinating care directly with someone receptive to the patient’s needs who can quickly and succinctly offer their perspective. The scheduling gymnastics of trying to fit one patient into clinic with two different providers along with ancillary services, such as pulmonary function testing, is a test of patience for support staff, but it does get a lot accomplished in one day. Ultimately, time up front to train support staff and schedule patients is rewarded with more streamlined appointments and testing.
Billing: Patients who need care from multiple specialists on one day often get multiple bills from specialists who complement, but do not repeat, each other’s work. Sometimes patients don’t want to see more than one specialist at a time, concerned that having another specialist see them is not really necessary when it isn’t clear, for example, that their interstitial lung disease is autoimmune in nature or if their sarcoidosis doesn’t extend beyond the lung.
Nonetheless, patient satisfaction with these clinics and the thorough evaluation for diseases with high morbidity are worth the time and cost.
Availability of providers with necessary expertise: No institution has access to every provider with expertise in rheumatic diseases. However, we have found that early career faculty members are often interested in developing a niche that can lead to further career advancement. To achieve expertise, a person must first have an interest and then gain experience. Further, the promise of collaborative care is part of the reason many of us practice in academia. As long as the interest and dedication are there, expertise can be built over time.
Limited physical shared space/limited clinic space: It is unrealistic to have all specialties in the same clinic space, especially because some need specific equipment (e.g., ophthalmology, otolaryngology) and clinic space is always limited. Having clinics in different areas around campus with providers who communicate closely can be a solution. Another solution is stocking supplies needed for other specialists in dedicated areas; our rheumatology clinic stocks supplies for patients who need to be seen by a dermatologist and oxygen tanks for pulmonary patients to facilitate our shared clinics.
Phone calls & messages: When multiple providers see one patient, who answers messages? In clinics where patients are booked for separate appointments, the provider who saw the patient typically takes the messages. In clinics where one provider coordinates care, that provider takes most messages. However, many multidisciplinary clinics use a message pool, in which all providers have access to a shared in-basket for that clinic. Providers can either answer messages as they come in or divide time so that each week a different provider is responsible for the pool. Any of these solutions can be effective; however, this is ideally decided when planning the clinic.
